Stapedectomy and stapedotomy are the techniques currently used in the surgical treatment of otosclerosis. During the period 1977-81, a total of 60 consecutive patients were subjected to surgery for otosclerosis according to the method of Schuknecht (Gelfoam and wire prosthesis). Another 55 consecutive otosclerotic patients were operated on during 1987-91with stapedotomy, according to the method advocated by Fisch (Fisch-type piston). Independent of the surgical technique used, the maximal hearing gain was obtained 1 year after surgery. In the frequency range 0.5-3 kHz, the mean value of the averaged pure tone thresholds improved from 52 to 28 dB in the stapedectomy group and from 57 to 26 dB in the stapedotomy group. In the frequency range 4-6 kHz, the subjects' hearing was not significantly improved in the stapedectomy group, whereas the subjects' hearing in the stapedotomy group improved from 61 to 44 dB. Per- and postoperative complications were low in both groups, except for one patient in the stapedectomy group who experienced the serious complication of a deaf ear after surgery.

In order to examine whether a myringotomy made with a CO2-laser might be alternative to a ventilation tube, a perforation was made in the upper rear quadrant bilaterally, of 22 rats. The laser-made perforations showed a delayed healing pattern, about twice the closing time of a similar-sized perforation made with a myringotomy lancet. Serous effusion was constantly observed in the attic space during the first 9 days but only in one ear was there actual discharge through the perforation. The size of the perforation started to diminish when the hyperplastic keratinizing squamous epithelium reached the perforation border.

A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1 % hyaluronan (Healon®; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with pure-tone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15 %) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases.

The rat eustachian tube (ET), from the nasopharyngeal orifice to the tympanal orifice, is about 4.5 mm long, of which the naso-medial membranous part (the nasopharyngeal orifice) measures about 1.5 mm and the occipito-lateral bony portion about 3 mm. The nasopharyngeal orifice is surrounded by two soft, lip-like, mucosal swellings--one ventral and one cranial--both easily mobile. The muscles related to the tubal opening mechanisms are the salpingopharyngeus, the tensor veli palatini and the levator veli palatini muscles. The salpingopharyngeus muscle originates partly from the cranial lip, whereas the palatal muscles originate partly from the ventral lip. The tympanal two thirds of the mucosal lining of the ET is cranially guided by a cartilage and incompletely framed by bony structures. The tympanal orifice is situated in the nasal part of the medial wall, well above the floor of the bulla. The tensor tympani muscle does not seem to take part in the opening and closing mechanisms of the ET. The mucosal lining of the ET consists of a respiratory epithelium with numerous glands in the lamina propria. It is suggested that the tubal muscles control the passage through the ET by moving the lip-like folds of the nasopharyngeal orifice. The anatomy of the rat ET is comparable to that described in Homo and it can be concluded that the rat ET might be a good model for studying the function of the human ET.

In 1996 a telemedicine link was established between two primary-care centres of Västerbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultation. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.